Antiretroviral Efavirenz Associated with Increased Suicide Risk

Antiretroviral regimens containing efavirenz are associated with a doubling of risk for suicidality in patients with HIV, compared with efavirenz-free regimens, finds a retrospective study in the Annals of Internal Medicine. The drug's label already includes a warning about the risk for psychiatric events, including suicide, but it was uncertain whether the relationship was causal.

In four studies, some 5300 antiretroviral-naive patients with HIV were randomized to regimens either with efavirenz (600 mg daily) or without.

After roughly 96 weeks, the primary outcome of suicidality -- suicidal ideation or attempted or completed suicide -- had occurred at an incidence rate of 8.08 per 1000 person-years in the efavirenz group, versus 3.66 per 1000 in the efavirenz-free group. The efavirenz group also had more completed suicides.

The authors note: "When efavirenz is used as a component of antiretroviral therapy, patients should be monitored carefully for exacerbation of depression or evidence of suicidal thoughts or behavior."

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